Friday, June 29, 2012

Many states were delaying their decision on whether or not to build a health insurance exchange until the ruling on the Supreme Court. With the decision handed down yesterday that the whole law in indeed constitutional, states will now have to decide whether or not to create their own state run exchange or rely on the exchange set up by the federal government. So where do states stand? Over the next few weeks, we'll find out who will go with a state run exchange.

For now, here is where some states stand after the ruling:

Colorado had already begun building a state exchange. Repbulicans in the state belive the ruling was truly a good thing for their state. Their Colorado Benefit Exchange is set to launch in October 2013. According to Bloomberg Business Week, 13% of the state is currently uninsured.

Montana was one of the states who declined to join the others who brought the law suit to the Supreme Court. The state believes it has done the right thing, and as a result has continued to work with the federal government in order to make an exchange for its citizens. Bloomberg Business Week states that their private insurers now have a deadline of next fall to submit their policies that will be available on the exchange to the uninsured citizens of their state.

Minnesota will also be moving ahead with it's health insurance exchange. Their governor Mark Dayton began building the exchanges in 2011. It is expected that they will move full steam ahead according to MinnPost. A 15 member task force has been working together to develop the blueprint for the state, which they will have completed by 2014. A compelete timeline of this rollout can be found here. And the letter sent by Minnesota Healthcare Leaders about the exchange can be read here.

New Jersey's Governor Chris Christe has stated he will still not start the creation of a health insurance exchange. He believes that if there is a change in ruling from the Presidential office, there will no longer need to be a health insurance exchange. Bloomberg Business Week also states that Christie will comply with any hard deadlines that are set forth by the government.

Nebraska's sentiments are much the same. Governor Dave Heineman will be further looking at the law and decide what it means for Nebraskans. He will also keep in mind that many things could change if Mitt Romney is voted into office this coming November. Read more at Omaha.com.

South Dakota's Governor Dennis Daugaard follows suit with Nebraska and New Jersey, stating he has no intention in starting an exchange without fully analyzing all parts of the law. He will protect South Dakota from the harmful pats and believes that things could change after the November elections. CBS News states that in 2010, the state had 10% of the population that was uninsured.

To get ahead of the game, join us this November to learn more about creating exchanges. The Health Insurance Exchange Congress will be held November 13-14, 2012 in Chicago, IL. Here, state officials and health plans with the only opportunity to come together to discuss PPACA and strategize on how to make this a successful opportunity for all. For more information on this year's agenda, download the program here. As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate!

When Walter Isaacson wrote Steve Jobs’ biography, one of the key lessons he learned from Jobs was that when you’re behind, you have to find a way to stand out, and be better than the rest. Now that the Supreme Court has upheld the majority of the ACA, there’s a lot of work to be done prior to January 1, 2014. And a lot of plans (and states) are behind but the good news is, there’s still enough time to catch up if you’re willing to leapfrog. So how can you help your organization move to the head of the pack? Attend the Health Insurance Exchange Congress.

The Health Insurance Exchange Congress is the only event where plans and states with first-hand experience preparing and implementing share their knowledge so you know what works and what doesn’t for exchanges so you can best manage your time to succeed when participating on health insurance exchanges.

More than 25 state and health plan speakers will share their know-how working on different aspects of exchanges in these states: Washington, Oregon, California, Utah, Colorado, Maryland, Connecticut, Rhode Island, Vermont and Massachusetts.

The Health Insurance Exchange Congress will take place November 13-14, 2012 in Chicago, IL. As a reader of this blog, you’ll save 15% off the standard rate when you register to join us and mention code XP1710BLOG!

I’ll let #3 speak for itself because honestly, what else is there to say when a major news organization is so monumentally wrong on our President’s defining piece of legislation?

I also won’t expound on #2 except to say that I’m honestly in shock.

So let’s focus on #1, which is really what’s important. This is arguably the most important SCOTUS decision since Bush v. Gore because it decided the direction of the country for the following four years. This decision, affects everyone in the country, from birth to death. That’s a lot longer than four years. While those on the left are whooping it up and patting each other on the back, the reality is that there is still the looming specter of its demise, if the Republican candidate, Mitt Romney, is elected President. He has promised to undo PPACA.

But that possible reality is still many months away and so for now, it signals many things, including the continuing expansion of Medicaid, which will directly affect the Medicaid Drug Rebate Program and other government reimbursement programs, like the 340B program. There are questions though. The only part of the law that was restricted, was seems to be this expansion. SCOTUS’ opinion says, “the Medicaid expansion violates the Constitution by threatening States with the loss of their existing Medicaid funding if they decline to comply with the expansion.” This decision gives states some flexibility not to expand their Medicaid programs, without paying the same financial penalties that the law called for. What is uncertain, is which states will choose to expand Medicaid and which won’t, meaning how many Americans will be added to the Medicaid program, and how much more rebating will branded and generic manufacturers have to do? As more experts weigh in, we’ll dissect this a bit more.

But for now, at least the decision has been made and we can all exhale. The changes the pharmaceutical and healthcare industries have already made to implement PPACA are not for naught….until possibly November.

Wednesday, June 27, 2012

One day left. Last moments of scrambling, a few people hyperventilating, sweat dripping down faces and everything else that goes with fear, anxiety, and nervousness will end tomorrow. Well, at least the decision will be known and politicians will go from there. And some are doing some last minute preparations just in case ACA is passed tomorrow and some are prepared.

Michigan’sGov. Rick Snyder is considering partnering with
the federal government to run health insurance exchange, according to the Lansing State Journal. Michigan is doing this
because they feel that they do not have enough time to set up the exchanges.
House Republicans refused a $9.8 million in federal planning to start a health
marketplace. State Licensing and regulatory Affairs Director Steve Hilfinger
warned the state for months that Michigan could run out of time to get a state
health exchange approved by January. Snyder is one of few Republican Governors
who actually felt that the health insurance exchanges were very helpful for
individuals and small companies to compare health-care. The state also did not
do detailed information technology work required to map out an exchange.
Michigan has been planning and plotting to establish state exchange costing as
much as $1 million but they have still been talking to federal officials about
actually setting it up.

Indiana is also waiting until tomorrow to see if the ruling on health care will pass. According to the San Francisco Chronicle, Indiana was preparing for the health insurance exchanges for a year and a half but even with the preparation, they believe that they will still need the federal government for assistance if it is passed. Gov. Mitch Daniels ordered state agencies to investigate the cost and feasibility of an online health insurance marketplace back in January 2011. However, Indiana has not enacted a law creating an exchange.

Illinois also is not as prepared for the possibility if
the law is passed. They realized that with the decision coming down from the
court Thursday, they see that they do not have enough time to set up the
exchanges, according to the State Journal Register. Now the state received three grants that total $39 million to start
building legislature for the exchange program but the legislature failed to
pass a law in order to establish it.

Nebraska is ready for health exchanges if the law is passed, according to CNBC. The state doesn’t have one set up but they are planning on set up an exchange marketplace.
If the ruling of the healthcare reform is struck down, then Nebraska but if the
law is upheld, then there will be a scramble to establish the state-run
exchange program. Republican Governor Dave Heineman is exploring the option of
using his executive order to get the state exchanges ready. Yes the Governor is
not a huge fan of ACA, but the exchanges are a good thing in his opinion. Heineman
has gone so far as to order the Department of Insurance to plan for the federal
requirements.

This November, the Health Insurance Exchange Congress
will be held November 13-14, 2012 in Chicago, IL. Here, state
officials and health plans with the only opportunity to come together to
discuss PPACA and strategize on how to make this a successful
opportunity for all. For more information on this year's agenda, download the program here. As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate!

As we count down the hours until the Supreme Court decision on the constitutionality of healthcare reform, let’s take a look back at Howard Dean’s talk on Healthcare Reform at the 2011 Medicaid Drug Rebate Program Summit.

He looks at the current state (pre-Supreme Court decision) of heatlhcare, looking at Mitt Romney's Massachusetts plan, shares why the reform isn't really reform as it's still currently working with today's system. He shares that the major cost of the way we run healthcare is in fact the way healthcare is provided itself. The system is built around receiving money from payors, there is no incentive in the system to provide preventative care or to save money.

Tuesday, June 26, 2012

We have two days until the decision will be heard and our politicians will figure out the next steps in health care reform. Still, with
two days left to worrying whether or not Patient Protection and Affordable Care
Act, states and state officials preparing for the possibility of the
act being upheld and a democratic Governor disagrees with the individual
mandate.

In Missouri, Democratic Governor Jay Nixon has expressed his
displeasure with the requiring of individuals to buy health coverage, according to St. Louis Public Radio. He wanted
to make it clear his feelings regarding the ACA to what he calls “Washington
Healthcare Law”.

Also expressing disinterest with the health care reform, Governor Scott Walker of Wisconsin said that no matter what happens on Thursday, he will not act on any of the provisions in the act until November, according to Milwaukee Public Radio. And what's going on in November? The general election. And, what does Walker believe? Yes, he wants to, rather he believes that Mitt Romney will be in office in November.

In Florida, changes are being made to help improve their
already standing health exchange program, according to Market Watch. Xerox has decided to work with Florida’s
health exchange program entitled Florida Health Choices to build health
insurance marketplace in Florida Health Choices. The contract is reportedly
going to last 9 years and it will be valued at $68 million. The insurance
marketplace Xerox is going to design will give Xerox is going to provide a
cloud-based web portal, an online plan tool to give consumers and employers
more information when making health insurance sections. Xerox will also provide
eligibility determination and an enrollment management services for the program
and it will operate as a customer contact center to share information on
marketplace offerings.

In Mississippi, there is someone who feels that part of the
ACA is actually a good thing for his state, according to the Desoto Times. The State Insurance commissioner
Mike Chaney feels health insurance exchange as crucial tool to broaden health
care of Mississippians. He feels that this is not a Republican idea, a Democrat
idea, but a universal idea. Stating the obvious, Chaney also believes that
Mississippi will be in better shape than neighboring Louisiana, who has not
taken any steps towards making exchanges. And in buying into that reasoning, Chaney
has taken steps to see it implemented gathering proposals of companies would
enter the exchange. When he was in office until 2009, he brought up legislature
for the exchanges, but of course, it was not passed. But Chaney realized with
his new position, he was going to use that pull in order to get the exchanges
ready. And with his pull, he decided to take the government’s $22 million in
startup funds.

This November, the Health Insurance Exchange Congress
will be held November 13-14, 2012 in Chicago, IL. Here, state
officials and health plans with the only opportunity to come together to
discuss PPACA and strategize on how to make this a successful
opportunity for all. For more information on this year's agenda, download the program here. As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate!

Monday, June 25, 2012

The wait will have to be delayed a little longer. According to The Huffington Post, the ruling on health-care reform has been pushed back by the justices. Which means that you could expect the ruling to come out Thursday according to the report. But you're not alone in the wanting the verdict to come already, your state officials feel the same.

Michigan has gone forward with the idea of starting up the exchanges by passing a bill including two of them that don’t seem to coincide with each other, according to Michigan Capital Confidential. One of the exchanges dictates if the person will go under Medicaid or government approved insurance policy which will then look at the income and access the amount of subsidies one gets. The other involves individuals to benefit from tax deduction employers are allowed to take for the employee health coverage cost.

Florida Governor Rick Scott has made it clear where he stands regarding healthcare reform, according to the Miami Herald. He believes that the Supreme Court will ultimately side with them and the 25 other states involved in the lawsuit against the President’s Patient Protection and Affordable Care Act. Gov. Scott went on to say that even if this law is, it will be repealed before it goes into action in 2014, sighting that is the reason why the state will not rush to implement the law. The governor is deciding to put all his eggs in one basket, in hopes that Republican nominee Mitt Romney will be elected President this November. And the issue of state-run health insurance exchanges, the governor believes that if it were useful, the private sector would have created it by now.

Hypotheticals are still circulating, awaiting the all-important verdict by the justices. One such hypothetical is the survival of the health insurance exchanges if the law is struck down.

CNN Money writes that the idea of health insurance exchanges could actually survive even if the courts decide to strike down health care reform. Some states have decided to contact Utah, who already had the exchanges set up before the reform passed, to figure out the ins and outs of the state-run exchanges. What’s even more attractive to the states is the idea of taking some of the burden off health-care programs like Medicaid if more people fewer people were insured.

The Washington Post writes that businesses would not be thrilled if the law went out the window. The millions of dollars they would lose if new people were going to be insured would mean less profit.

This November, the Health Insurance Exchange Congress will be held November 13-14, 2012 in Chicago, IL. Here, state officials and health plans with the only opportunity to come together to discuss PPACA and strategize on how to make this a successful opportunity for all. For more information on this year's agenda, download the program here. As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate!

Friday, June 22, 2012

In today's exchange update, we see many states continuing to put off the opportunity to set up a state-run exchange, either in favor of the federal exchange or awaiting for the Supreme Court ruling on the constitutionality of the act.

In Vermont, theyv'e created the Health Insurance Exchange Cooperative - a new insurance to help their exchange. With a loan of $33.8 million form the federal government, they will create a version of health insurance that is good for Vermont. According to the Burlington Free Press,

Meanwhile in New Hampshire, Governor John Lynch has signed a bill that prohibits the state from creating a state run exchange.He did this with the encouragement of the State Insurance Department. According to the Concord Monitor, he believes that if the bill is upheld, then his state will benefit from a federal exchange.

According to MedicalXpress target="_blank", Maryland has already begun building their state exchange. Their main concern is that when the healthcare law is upheld by the Supreme Court in their ruling next week, that they'll have to find a balance between funding the exchange and their growing portion of Medicaid beneficiaries. Dushanka Kleinman, Public Health associate dean for research and co-chair of the Maryland Health Benefit Exchange Board's Finance and Sustainability Advisory Committee believes that many things in the law should be done by the states anyway, and the state will continue to improve their health care system for the citizens of their state.

This November, the Health Insurance Exchange Congress will be held November 13-14, 2012 in Chicago, IL. Here, state officials and health plans with the only opportunity to come together to discuss PPACA and strategize on how to make this a successful opportunity for all. For more information on this year's agenda, download the program here. As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate!

Thursday, June 21, 2012

The 2nd Annual Health Insurance Exchange Congress agenda is now ready for download. This is the only event that will take you from the hypothetical to the actual. Not only will you hear how top plans are planning for exchange participation, but this is the only event where you’ll hear directly from the states with unique experiences building and implementing their exchanges.

The Health Insurance Exchange Congress will take place November 13-14, 2012 in Chicago, IL. As a reader of this blog, you’ll save 15% off the standard rate when you register to join us and mention code XP1710BLOG. If you have any questions about the program, feel free to email Jennifer Pereira.

Today's guest post is contributed by Miree Lee of M. Lee Consulting, LLC. Miree will be presenting at the Medicaid Drug Rebate Program Summit this September 10-12, 2012 in Chicago, IL. If you'd like to join Miree at MDRP, register today and mention code XP1725BLOG to save 25% of the standard rate!

It's going to be a hot summer and it's not just because we are based out of Scottsdale, Arizona where temperatures regularly reach 115+ in July. That temperature is hot any way you cut it but what will really heat things up this summer in the midst of BBQs, fly fishing and summer vacations will be the U.S. Supreme Court decision on the constitutionality of the Patient Protection and Affordable Care Act ("PPACA").

Since the enactment of PPACA and supplemental legislation, "health care reform" has been an incredibly divisive topic, which makes for interesting dinner conversations particularly after a cocktail or two. From the constitutionality of the individual mandate and the possibility of the individual mandate to be severed from PPACA, to the constitutionality of Medicaid expansion, we expect the highest court to come to a decision shortly and the finish line for PPACA is in sight. Or is it?

The court's decision may have a profound impact on the industry from legal, policy, operational and financial perspectives particularly if PPACA is struck down materially or in totality. Following are some areas to consider:

• Increase in Medicaid Rebates: For non-innovator multiple source drugs, the Medicaid rebate increased from 11% of AMP to 13% of AMP. For single source and innovator multiple source drugs, the "greater of" calculation remains in effect (e.g. greater of AMP less Best Price and AMP multiplied be x%). However, the x% increased from 15.1% of AMP to 23.1% of AMP with the exception of blood clotting factors and drugs exclusively with pediatric indications where the x% is now 17.1% of AMP. The benefit between the difference between the "new" and "old" rebate rates goes to the Feds presumably to help offset federal expenditures associated with PPACA.

o Policy: Do methodology documents need to be revised? What impact will this change have on 340B drug pricing since the 340B ceiling price is directly tied to AMP and the Medicaid rebate from two quarters prior?

o Operations: Do systems need to be revised once again to accommodate changes to the URA calculations? Is CMS going to revise the URAs and submit to the state, which would precipitate hundreds of PQAS?

o Finance: Will we be entitled to refunds due to overpayments associated with the rebate rate change? How should we accrue for Medicaid rebates going forward (e.g. temporary decrease in accruals and expect additional legislation)?

• Managed Care Medicaid Rebates: Post-PPACA, Managed Care Medicaid Utilization is subject to the Medicaid rebate. To date, there are some key states, such as California, that have yet to submit Managed Care Medicaid utilization. If PPACA is struck down, will this be the end of the Medicaid rebates for Managed Care Medicaid utilization? My prediction would be "no" given prior legislative actions such as the Drug Rebate Equalization Act of 2009 that attempted to require manufacturer rebates for Managed Care Medicaid utilization. An interesting question will be whether the states will further revise the pharmacy benefit to be carved in or carved out of Managed Care Medicaid. From a manufacturer perspective, does this once again change the relationship between manufacturers and its contracting relationships with Managed Care Medicaid organizations?

• Line extensions and alternative rebate calculation: For companies that have implemented the alternative URA methodology, if PPACA is struck down, can such manufacturers recover the difference in rebates paid post-PPACA vs. rebates that would have been due pre-PPACA? In addition, manufacturer systems would likely need to be reconfigured to revert to the pre-PPACA URA calculation. Lastly, what impact would there be to 340B pricing?

• AMP definition: Perhaps one of the most complex ramifications associated with PPACA was the change in the AMP definition. If the law is declared unconstitutional, do we revert back to the Deficit Reduction Act of 2005 AMP methodology and the Final Rule of 2007. But wait...was not the Final Rule of 2007 withdrawn? Where does that leave us? Do we revise AMP inclusion and exclusion filters on a prospective basis? If so, do we need to restate prior period AMPs? Do we need to re-calculate smoothing of lagged price concessions to only includes discounts to pre-PPACA AMP eligible entities? What is the financial impact of reverting to the prior AMP definition? What are the costs associated with changing AMP filters and systems reconfigurations? What impact will the change to AMP have on 340B pricing?

• Federal Upper Limit: Post-PPACA the FUL is no less than 175% of average weighted AMP for pharmaceutically equivalent and therapeutically equivalent multiple source products that are available for purchase by retail community pharmacies on a nationwide basis. However, the DRA FUL was 250% of lowest AMP in a group of 2 or more multi-source drugs with the DRA FUL subject to litigation. How will the change to the FUL impact reimbursement?

• 340B New Covered Entities: PPACA included the following new covered entities Children's Hospitals (impact of Medicare and Medicaid Extenders Act of 2010 and ability to purchase orphan drugs at 340B ceiling prices), Free Standing Cancer Hospitals, Critical Access Hospitals, Rural Referral Centers and Sole Community Hospitals. If PPACA is struck down, do manufacturers who have sold single source and innovator multiple source covered outpatient drugs at 340B ceiling prices now a Best Price issue? What happens to all of the 340B program integrity provisions (manufacturer and covered entity compliance)?

• Medicare Part D Coverage Gap Discount Program: Beginning January 1, 2011, participating manufacturers of branded drugs agreed to provide a 50% of negotiated price (excluding dispensing fee) POS discount to Part D patients in the Part D coverage gap. Does the coverage gap discount program now cease to exist? Is this a contracting opportunity for Part D Plan Sponsors?

• Annual Branded Drug Fee: If PPACA is overturned, are manufacturers in a position to request a refund from the IRS? After all, the industry paid $2.5B in 2011 and will pay an additional $2.8B in 2012.

Now before we all cancel summer vacations to the Jersey Shore (definitely not referring to the MTV gang), Outer Banks or fly fishing trips to Montana or Maine, a big deep breath or two or three is in order. Given the potential material impact of the Supreme Court decision on the industry, it is not too late to analyze and assess the potential legal, policy, operational and financial impact of the decision to your organization. Over the course of the past several months, there have been some incredibly insightful discussions and presentations from counsel of the law firms of Epstein Becker Green, Hogan Lovells, King & Spalding, and Reed Smith. It might be a great opportunity to engage in discussions and commence contingency planning.

Wednesday, June 20, 2012

The news surrounding the health care and the President’s
universal health care law remains the same as the Justices wait to release
their decision. The month of June is coming to an end and whichever way the
justices go there will be a mixture of emotions ranging from outrage and
satisfaction to content and indifference.

Nonetheless, Governors, and advocates alike are still
voicing their opinion before the ruling is heard.

In Missouri, representatives are ready to put to vote a bill
that would prevent any health insurance exchanges by the state according to KBIA. The measure
states that no exchanges are to occur unless it is approved by legislature or
the voters’ approval. The bill also states that the governor cannot use an
executive order to have the exchanges into action. Also in an extreme attempt
of not having any exchange set up, the measure proposes to sue any state agency
or worker involved in exchange activity.

In Illinois, small businesses and health care advocates are
still demanding that Governor Pat Quinn use his executive order, like Rhode
Island and New York, to issue an executive order for the health insurance
exchanges. According to Fox Illinois, Gov. Quinn has expressed interest in using his executive order to
get the exchanges in place but nothing has been done so far. Advocates want action to
be taken whether or not the Justices rule in favor of Patient Protection and
Affordable Care Act, but the governors of fifteen other states seem to have a
similar approach to this situation.

The justices know that this decision will impact the country
one way or another. Assuming it passes people are going to be covered and helped with the
financial burden of coverage, with federal subsidies and state-run exchanges. But people
argue that now government can do anything now since the justices have
precedent if passed. The effects of striking down the act will lead to millions of people losing the health care they already have because of it being passed in
2010.

This decision is political and emotional, and The New Republic writer
Alex MacGillis echoes this very sentiment with his piece detailing the people
living in Tennessee and the attempts of finding affordable health care.

This November, the Health Insurance Exchange Congress
will be held November 13-14, 2012 in Chicago, IL. Here, state
officials and health plans with the only opportunity to come together to
discuss PPACA and strategize on how to make this a successful
opportunity for all. As a reader of this blog, when you register to
join us and mention code XP1710BLOG, you'll receive 15% off the standard rate!

Tuesday, June 19, 2012

The Supreme Court decision on universal healthcare will have a ripple effect on each state, whenever the court releases their verdict. The challenges that state legislature have is attempting to take the right amount of action in case the law is upheld. But no one seems to know just how to prepare for the possibility of an upheld ruling.

In California, it seems they are acting regardless of the ruling. The California Exchange Board will meet to discuss the next step in developing health insurance exchanges, according to California Healthline. The items that are going to be discussed include outreach, marketing, and insurance coverage assisters. But even with an aggressive approach to the law, there is still an air of uncertainty that looms over universal health care. Which is why Texas is not doing anything regarding revamping their health care until the ruling is heard in the coming days.

In Texas, they do not have an exchange set up in case of a Supreme Court ruling in favor of the law, which makes people like Anne Dunkleberg, associate director of Center for Public Policy Priority, worried about the possibility of having federally funded exchanges, according to Texas Tribune. In accordance with state Attorney General Greg Abbot, the realization for health care reform is necessary for the state. The Texas Health and Human Services Commission (HHSC) has, however, attempted to have certain measures but not Medicaid or state run exchanges.

The balance that is needed may not exist for the state. Some do not want to go as far as California, in essence taking to heart the act’s intention of providing affordable health care. Then you have states like Texas, trying to wait and see what the verdict will read and what steps they now have to take.

As a follow-up to the New Hampshire legislature entitled HB 1297, Governor John Lynch decided to sign the bill preventing state-run exchanges, according to New Hampshire Watchdog. No comment given as to why the bill was signed by the Governor, who is known for being in support of the Affordable Care Act (ACA).

This November, the Health Insurance Exchange Congress will be held November 13-14, 2012 in Chicago, IL. Here, state officials and health plans with the only opportunity to come together to discuss PPACA and strategize on how to make this a successful opportunity for all. As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate!

Monday, June 18, 2012

Each state is on pins and needles awaiting the deliberation
regarding the Affordable Care Act (ACA) in the coming days or weeks. The constant
thinking among states during the waiting game is to either hold off major decisions for the judgment, act regardless
of the ruling, or fight against what some on Capitol Hill deem an “unconstitutional”
law.

In New Hampshire, they have decided to do the latter. According to Heartland, the
House has agreed to a Senate legislature entitled HB 1297 which would prevent
state-run exchanges. Some Senators feel that this would prevent the insurance
department from talking to federal officials. Others feel that this legislature will help repeal ACA. The bill will be going to the
desk of Democratic Governor John Lynch, who supports state-run exchanges.

In
Massachusetts, a state that already has universal healthcare, will have its two
largest insurers extend two popular provisions in the ACA even if it is not
upheld by the Supreme Court. Insurers will extend young adult coverage to the
age of 26. Insurers would also cover an array of services with no copayments which
include certain immunizations, screening for diabetes, depression, and breast
cancer, according to the Boston Globe.

In Utah, however, they are taking backseat to the possibility of the legislature being overturn. Utah already has universal healthcare set up for
residents but unlike Massachusetts, they have decided not to take any more
action until a decision on ACA has been reached according to Kaiser Health News.

In Florida, they are attentive, waiting for the ruling towards the end of the month. But they are stuck between a rock and a hard place regardless of the Supreme Court ruling. In an article written for Rattler News, they describe how if
the law is upheld, Florida will have to start the exchange program, identify
at least two million people who would be eligible for Medicaid and distribute millions
to individuals and businesses. If the law is struck down, that could set off
the removal of young adults from the health insurance coverage of their
parents.

This November, the Health Insurance Exchange Congress
will be held November 13-14, 2012 in Chicago, IL. Here, state
officials and health plans with the only opportunity to come together to
discuss PPACA and strategize on how to make this a successful
opportunity for all. As a reader of this blog, when you register to
join us and mention code XP1710BLOG, you'll receive 15% off the standard rate!

Friday, June 15, 2012

In today's health insurance exchange update, we find that even though some states are against the health exchange, they're still taking the measures to create one one. and Hawaii is the first state to publicly declare that they will be creating a healthcare exchange to be compliant with the government.

Even though Mississippi is a red state, Mississippi Insurance Commissioner Mike Chaney says that the $20 million grant that the state received will be put to good use. According to Politico, they are creating an exchange, but there will be no standard packages, no requirements to sell to people with pre-existing conditions or subsidize the people buying the coverage. The goal of this exchange would be to help healthy people who can afford to buy health insurance find it easier.

Hawaii is the first state to officially declare that it will create a government compliant health plan. Governor Neil Abercrombie issued a letter to the US Health and Human Services Center for Consumer Information and Insurance Oversight that the Hawai'i Health Connector would function as their exchange. According to Maui Now, this platform was established in 2011 and has contributed to Hawaii achieving one of the lowest uninsured levels of children in the nation.

Montana and South Dakota, however, are less progressive when it comes to creating their health insurance exchanges according to Government Health IT. Both have many hospitals and doctors who have not adopted to electronic health records. South Dakota did receive a grant for exploration into the health insurance exchange, but they were a part of the law suit brought to the Supreme Court to determine the constitutionality of the law. Montana was not a part of hte exchange, but have accepted a $1 million grant to study their options. Both states have really high uninsured population averages, but also a higher than average number of individuals on Medicaid.

This November, the Health Insurance Exchange Congress will be held November 13-14, 2012 in Chicago, IL. Here, state officials and health plans with the only opportunity to come together to discuss PPACA and strategize on how to make this a successful opportunity for all. As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate!

Thursday, June 14, 2012

No one knows better than you that working in the Medicaid Drug Rebate space can get complicated. With 50 states + DC participating in the MDRP, that's 50 sets of invoices and more than 50 rebate payments (for those states that require separate payment for J Code, MCO and other programs) that need to be made on a quarterly basis. That means there are 50+ opportunities for overpayments and underpayments.

At the 17th Annual Medicaid Drug Rebate Program Summit, taking place this September 10-12, 2012 in Chicago, we know that a little information can go a long way, which is why we have our custom track, “State Contracts, Reporting and Operations Issues and Strategies,” so that you can hear from the States themselves about how they deal with challenges including:

- Accounting and Accruing for Rebate Claims When Invoices are Delayed to Prevent Liability

- Walk away with tools to deal with an challenges in forecasting overall rebate liability from representatives from North Carolina, Illinois and Kansas.

- Developing Best Practices for Dispute Resolution – Avoid needing dispute resolution by learning what States are grappling with and how to work with, rather than against them

We also give you the chance to meet with State Representatives for Dispute Resolutions!

For the past 10 years, MDRP has facilitated dispute resolution – so that pharmaceutical manufacturers and states can get up close and personal, and put an end to those disputes potentially worth millions of dollars. Who are the confirmed State Representatives so far? Texas, Oregon, New Jersey, Florida, North Carolina, Illinois, and Kansas.

Register now to reserve your spot with your State Representative! As a reader of this blog, you receive an exclusive discount of 25% off of the standard price when you register to join us this September 10-12, 2012 in Chicago, IL. Simply use priority code XP1726BLOG. Do you have any questions about the event? Feel free email Jennifer Pereira.

Wednesday, June 13, 2012

In the latest news on health insurance exchanges, there seems to be a problem with exactly who should have the coverage and the ever increasing feeling of the money being contributed to the coverages for residents.

In Massachusetts, a New York Times article discusses a system in place for health insurance exchanges. There was a legislation passed in 2006 called the Health Connector. Under that law, most residents are required to purchase health insurance and it creates an online marketplace to simplify buying a coverage plan that the residents can afford. Only is Utah the only other state that had health insurance exchange before the Affordable Care Act was mandated. Last year, we had the chance to sit down with Glen Shor of the Massachusetts Health Exchange and discuss the exchange. Listen to the podcast here.

But the fear that Health Connector has is that they need more people paying full premium price for their coverage. Of the 224,000 people insured through Connector, 82% pay next to nothing because of government subsidies. However, if the ACA legislature is upheld, then those low income households could shift to Medicaid under law’s expansion system.

But there is still a pressing issue with healthcare that lies with the possibility of covering immigrants.

In Oregon, Medicaid and other lawmakers tend to ignore the issue of providing primary medical care to immigrants. Immigrants may be able to find work (low-waged work at that) however the employer-sponsored coverage’s would not apply to them according to The Lund Report.

Despite the fear of paying for such exchanges and the problem of coverage for immigrants, some states are still continuing to develop plans to implement the exchanges necessary by the January 2014 start date, presuming the ACA is upheld.

In Washington, the Center for Medicare and Medicaid Services (CMS) plan to develop verification data, services to support coverage and eligibility insurance exchanges and seeks industry information about applications that are available, according to HealthCare IT News. In addition, due to limited access to employer-sponsored health insurance and restrictions with Medicaid, 47 percent of immigrants are uninsured. ACA would increase options for some immigrants and citizens.

In Arkansas, the Arkansas Advocates for Children and Families developed a report entitled "Making Sure the Health Insurance Exchange Works for Families." The report will be used to help residents through the exchange process based on their income and what plan fits for them, according to a blog post on the Arkansas Times.

This November, the Health Insurance Exchange Congress will be held November 13-14, 2012 in Chicago, IL. Here, state officials and health plans with the only opportunity to come together to discuss PPACA and strategize on how to make this a successful opportunity for all. As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate!

Tuesday, June 12, 2012

In the latest news regarding state’s health care exchanges, there is still uncertainty that looms over the Supreme Court decision of Affordable Care Act (ACA) and how to go about the possible exchanges. Some states are preparing for the possibility of the ACA being upheld in the Supreme Court.

In California, The California Healthcare Foundation and a group of investors released a technical prototype and a road map for states and the federal government to create health insurance exchange. This new system is called the Enroll UX 2014 and it offers a blueprint for an online process for application, eligibility determination, enrollment and health plan selection. The Enroll UX 2014 can be customized by states to be the public face of their health insurance exchanges, according to Healthcare It News.

California is not the only state that is participating in Enroll UX 2014; Illinois, Arkansas, Tennessee, Missouri, Minnesota, New York, Oregon, Massachusetts, and Alabama decided to join in case of an upheld ruling from the nine justices this summer.

In Oregon, a survey was composed of small business backing the health insurance exchange. Oregon has put aside a health insurance exchange that would provide a marketplace through 2014, allowing consumers to compare cost according to Portland Business Journal.

However, there are states that are not as eager to take the route of a California and company to prepare for the possibility of an upheld Supreme Court ruling.

In Maine, State Republican Senators passed a bill that creates a network of licensed “navigators” to help the citizens of Maine in the tricky world of insurance. This bill will not take effect unless the Affordable Care Act is upheld. Some Republicans feel that with this bill, they can be protected if the government sets up an exchange, where as some Democrats feel that there will not be enough time to set up this complex system, according to the Morning Sentinel.

This November, the Health Insurance Exchange Congress will be held November 13-14, 2012 in Chicago, IL. Here, state officials and health plans with the only opportunity to come together to discuss PPACA and strategize on how to make this a successful opportunity for all. As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate!

Friday, June 8, 2012

Can your company afford hundreds of millions of dollars in fines? The latest fine that made headlines was for a staggering 1.5 BILLION dollars. Fines like these go well beyond the cost of doing business. With company budgets shrinking, you can’t afford to make a mistake that could cost your company millions of dollars in fines. If you want to find out what the Office of the Inspector General is working on right now, and how that will impact your business, at the 17th Annual Medicaid Drug Rebate Program Summit, we have officials from the Office of the Inspector General presenting their annual Work Updates. In this session, they will provide an update on several of their latest evaluations involving Medicaid rebates and payment methodologies, as well as discuss the potential areas of future work outlined in the OIG work plan.

Featured Session:OIG Work UpdatesFeatured Speakers: David Tawes, Director, Prescription Drug Pricing Evaluation, Department of Health & Human Services
Stephanie Yaeger, Program Analyst, Team Leader OIGOEI,, Department of Health & Human Services
Robert Vito, Regional Inspector General, Department of Health & Human ServicesAbout the session: OIG will provide an update on several of their latest evaluations involving Medicaid rebates and payment methodologies, as well as discuss the potential areas of future work outlined in
the OIG work plan.

Thursday, June 7, 2012

In today's health insurance exchange news, we see that many of the struggles that come with creating the exchanges are what should be covered and how the states are going to create the right platform for their exchanges.

In Illinois, a few organizations are banding together to encourage Governor Pat Quinn to give executive orders to begin the creation of the health insurance exchange. The organizations include Illinois State AFL-CIO, League of Women Voters of Illinois and Illinois Black Chamber of Commerce and others according to the Journal Star. These organizations believe that the only way for the state to get its own exchange is to start the process now so they won't be forced to use the federal exchange in 2014.

Washington University in Saint Louis believes that pricing in counties for the exchanges where there is no competition could be inflated. They believe that policy makers need to monitor the counties where few insurances are competing to ensure the best price for their residents, the reason the health insurance exchanges were created.

What is required to be covered in the healthcare insurance exchanges is still up in the air. Health and Human Services has tasked three insurance companies with reporting data including covered benefits, treatment limitations, a list of covered drugs, along with information on whether each drug is subject to prior authorization and/or step therapy and plan enrollment data for their highest-enrollment plans in addition to bench mark plans and administrative data. Information Week also notes that the HHS has also named National Committee for Quality Assurance (NCQA) and URAC as accreditors to make sure the exchanges meet government standards.

This November, the Health Insurance Exchange Congress will be held November 13-14, 2012 in Chicago, IL. Here, state officials and health plans with the only opportunity to come together to discuss PPACA and strategize on how to make this a successful opportunity for all. As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate!

Monday, June 4, 2012

Many states are preparing to implement health insurance exchanges. With the final word on the Supreme Court hearing due out later this month, states are taking different approaches on how they're working with their exchanges.

In California, Accenture was given $359 million to build an online eligibility and enrollment system for for the exchanges. With enrollment set to open October 1, 2013, they are contracted to both build and maintain the system after the health insurance exchange is open for business according to iHeartBeat.

In New Hampshire, the House sided with the Senate to block the start of developing an insurance system. They've done so in part because they believe that the ACA bill would not allow for enough communication between the New Hampshire Department of Insurance officials and the federal government for the creation. There also wouldn't be enough input from the tax payers, who would ultimately be funding the project according to the New Hampshire Watch Dog.

In Minnesota, they believe that even if healthcare reform doesn't stand in front of the Supreme Court, it's still at the top of their minds. They see technology as the key to make healthcare reform possible. Due to healthcare innovation in the state since the 1990s, they believe they are ahead of the curve. Insurance companies, doctors and hospitals have all begun working together to breakdown the barriers of previous healthcare programs. Locals in the state do look forward to the clarity that it will bring to insurance availability through small businesses according to the Star Tribune.

This November, the Health Insurance Exchange Congress will be held November 13-14, 2012 in Chicago, IL. Here, state officials and health plans with the only opportunity to come together to discuss PPACA and strategize on how to make this a successful opportunity for all. As a reader of this blog, when you register to join us and mention code XP1710BLOG, you'll receive 15% off the standard rate!